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Indian Pediatr 2011;48: 910 |
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Changing Spectrum of Malnutrition in Urban
Cities |
Bhavneet Bharti and Upender Shava,
Department of Pediatrics, Advanced Pediatrics Center,
PGIMER , Chandigarh 160 012, India.
Email: [email protected]
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We read with interest the recent study published in [1] regarding
persistent levels of undernutrition in city like Chandigarh. The authors
have concluded that the prevalence of underweight among under-five year
old children remained almost stagnant in the last one decade from 51.6%
(1997) to 50.4% (2007). We would like to point out that sampling frame and
design of the published study pose limitation in inferencing the
prevalence estimates to the whole population of Chandigarh. Their study
selectively sampled only one stratum of the society i.e. the children
attending the Anganwadis or the non-registered children staying in close
proximity of these Anganwadis. There are nearly 420 Anganwadis in
Chandigarh city out of which only 10% of the Anganwadis are located in
urban centers whereas rest of the centers are either in rural or slum
areas which constitute 40% of total population of Chandigarh. These
centers primarily cater to the marginalized populations and study
evaluating children in these centers has disproportionately aggravated the
overall level of undernutrition in the population of Chandigarh due to
sampling and selection bias.
We have also carried out a cross-sectional survey to
quantify the prevalence of malnutrition in Chandigarh city in the year
2009 using multistage cluster design with probability proportional to size
(PPS) sampling on the pattern of the NFHS -3 [2]. A total of 30
non-overlapping clusters, stratified as urban (n=18), rural (n=3)
and slum (n=9), were selected randomly across the Union territory
of Chandigarh. The prevalence of undernutrition (using WHO standards)
estimated in our study sample of 597 children is 23.6% ( 95% CI:
20.2-27.0%) which is almost half of estimate reported by them.
Second, the estimated prevalence of underweight in
children also depends upon the standards used for comparison. In children
less than 5 years the estimated prevalence is nearly 1.4 times higher when
IAP standards rather than the new WHO standards are used, with the
absolute difference being 14.5%. Therefore the prevalence estimated by
Thakur, et al. [1] to be 50.4% as per IAP standards should read as
35.7% as per WHO standards [3].
The comparisons of malnutrition rates with (Punjab and
Haryana) made during discussion section in the paper have been made with
the figures from NFHS -3 which are presently using WHO growth standards to
permit International comparisons [4]. In order to facilitate the analysis
of changes in nutritional status over time, nutritional status in NFHS-2
were recalculated using the new WHO standard to make valid comparisons .
So the comparison of prevalence estimates of underweight using IAP
standards cannot be made with the figures used in NFHS-3 figures unless
recalculation is done using WHO standards from the raw data.
Third, the analysis by Thakur, et al does not
describe the levels and trends of overweight in the preschool children. We
estimated the prevalence of overweight children, (defined as BMI for age Z
score ≥2) in our
population to be 6% (36/597) which is above the national average. (Urban
3.5%, Rural 2.1%) [4]. The prevalence of overweight and obesity observed
in developed countries is about double that in developing countries (11.7%
and 6.1% ) but the decadal trends have revealed that the relative increase
has been higher in the developing countries (+65% vs +48%) [5].
Therefore, the interventional programs in the urban
cities like Chandigarh must be targeted to reduce the prevalence of
undernutrition on one hand and prevent the onset of overweight in children
<5 years on the other hand to tackle the dual burden of malnutrition.
References
1. Thakur JS, Prinja S, Bhatia SS. Persisting
Malnutrition in Chandigarh: Decadal underweight trends and impact of ICDS
program. Indian Pediatr. 2011;48:315-8.
2. Shava U, Bharti B, Bhalla AK, Thakur JS . Prevalence
of childhood malnutrition in Chandigarh : A population based survey.
Thesis MD Pediatrics, Postgraduate Institute of Medical Education and
Research, Chandigarh; December 2009.
3. Prinja S, Thakur JS, Bhatia SPS. Pilot testing of
WHO child growth standards in Chandigarh: Implications for India’s child
health programs. Bull WHO. 2009;87:116-22.
4. International Institute of Population Sciences and
ORC Macro. National Family Health Survey–3. Mumbai: International
Institute of Population Sciences and ORC Macro; 2007.
5. de Onis M, Blossner M, Borghi E. Global prevalence
and trends of overweight and obesity among preschool children. Am J Clin
Nutr. 2010;92:1257-64.
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